Abstract

BackgroundWe hypothesized that heterogeneity exists within the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 spirometric category and that different subgroups could be identified within this GOLD category.MethodsPre-randomization study participants from two clinical trials were symptomatic/asymptomatic GOLD 1 chronic obstructive pulmonary disease (COPD) patients and healthy controls. A hierarchical cluster analysis used pre-randomization demographics, symptom scores, lung function, peak exercise response and daily physical activity levels to derive population subgroups.ResultsConsiderable heterogeneity existed for clinical variables among patients with GOLD 1 COPD. All parameters, except forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC), had considerable overlap between GOLD 1 COPD and controls. Three-clusters were identified: cluster I (18 [15%] COPD patients; 105 [85%] controls); cluster II (45 [80%] COPD patients; 11 [20%] controls); and cluster III (22 [92%] COPD patients; 2 [8%] controls). Apart from reduced diffusion capacity and lower baseline dyspnea index versus controls, cluster I COPD patients had otherwise preserved lung volumes, exercise capacity and physical activity levels. Cluster II COPD patients had a higher smoking history and greater hyperinflation versus cluster I COPD patients. Cluster III COPD patients had reduced physical activity versus controls and clusters I and II COPD patients, and lower FEV1/FVC versus clusters I and II COPD patients.ConclusionsThe results emphasize heterogeneity within GOLD 1 COPD, supporting an individualized therapeutic approach to patients.Trial registrationwww.clinicaltrials.gov. NCT01360788 and NCT01072396.

Highlights

  • Considerable heterogeneity existed for clinical variables among patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 chronic obstructive pulmonary disease (COPD)

  • According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) [1] spirometric classification, mild airflow obstruction is defined by a post-bronchodilator forced expired volume in 1 second (FEV1) to forced vital capacity (FVC) ratio at a fixed cut-off of

  • Results obtained in all patients with GOLD 1 COPD and controls were first shown as frequency distributions and compared between the two groups using Pearson’s Chi-squared statistic tests

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Summary

Introduction

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) [1] spirometric classification, mild airflow obstruction is defined by a post-bronchodilator forced expired volume in 1 second (FEV1) to forced vital capacity (FVC) ratio at a fixed cut-off of

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